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DOI: 10.1055/a-2641-5725
Efficacy of endoscopic intermuscular dissection vs. endoscopic submucosal dissection in treating rectal neuroendocrine tumors < 10 mm
Supported by: National Natural Science Foundation of China 82341019

Abstract
Background and study aims
Rectal neuroendocrine tumors (r-NETs) exhibit significant heterogeneity and malignant potential. Currently, endoscopic resection is the preferred treatment for r-NETs < 10 mm. However, traditional endoscopic resection carries a risk of positive vertical margins. This study aimed to compare clinical efficacy of endoscopic intermuscular dissection (EID) and endoscopic submucosal dissection (ESD) in treating small r-NETs (< 10 mm).
Patients and methods
This retrospective study included 56 patients with r-NETs < 10 mm who underwent endoscopic treatment between April 2017 and September 2024 at Shenzhen University Affiliated South China Hospital and Shenzhen Hospital of Southern Medical University. All procedures were performed by the same surgeon. Patients were divided into two groups based on type of endoscopic treatment: the EID group (n = 16) and the ESD group (n = 40). We compared operative time, technical success rates, resection outcomes, adverse event (AE) rates, and histopathological findings between the two groups.
Results
Median lesion size in the EID group (7.5 mm) was significantly larger than in the ESD group (6.0 mm) (P = 0.001). Although operative time in the EID group was longer (39 vs 28.5 minutes), the difference was not statistically significant (P = 0.137). The complete resection rate was 100% in the EID group and 97.5% in the ESD group, with no statistically significant difference. There were no significant differences in general characteristics, technical success rates (100% vs 100%), or incidence of AEs (bleeding, perforation, infection) (0% vs 0%) between groups (P > 0.05).
Conclusions
Endoscopic intermuscular dissection offers a better option for preventing positive basal margins and demonstrates good safety and feasibility.
Keywords
Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...) - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...)Publication History
Received: 22 January 2025
Accepted after revision: 18 June 2025
Accepted Manuscript online:
23 June 2025
Article published online:
06 August 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Guang Yang, Jingsong Wang, Bo Li, Xiaolong Xian, Jianzhen Ren, Qiuping Qiu, Xiaoping Hong, Longbin Huang, Suhuan Liao, Silin Huang. Efficacy of endoscopic intermuscular dissection vs. endoscopic submucosal dissection in treating rectal neuroendocrine tumors < 10 mm. Endosc Int Open 2025; 13: a26415725.
DOI: 10.1055/a-2641-5725
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